Ludwig’s angina is a rare skin infection that occurs on the floor of the mouth, underneath the tongue. This bacterial infection often occurs after a tooth abscess, which is a collection of pus in the center of a tooth. It can also follow other mouth infections or injuries. This infection is more common in adults than children. Usually, people who get prompt treatment recover fully.
The symptoms include swelling of the tongue, neck pain, and breathing problems.
Ludwig’s angina often follows a tooth infection or other infection or injury in the mouth. The symptoms include:
- pain or tenderness in the floor of your mouth, which is underneath your tongue
- difficulty swallowing
- problems with speech
- neck pain
- swelling of the neck
- redness on the neck
- an earache
- tongue swelling that causes your tongue to push against your palate
- a fever
Call your doctor if you have symptoms of Ludwig’s angina. As the infection progresses, you may also experience trouble breathing and chest pain. It may cause serious complications, such as airway blockage or sepsis, which is a severe inflammatory response to bacteria. These complications can be life-threatening.
You need immediate medical attention if you have a blocked airway. You should go to the emergency room or call 911 if this occurs.
Ludwig’s angina is a bacterial infection. The bacteria Streptococcus and Staphylococcus are common causes. It often follows a mouth injury or infection, such as a tooth abscess. The following may also contribute to developing Ludwig’s angina:
- poor dental hygiene
- trauma or lacerations in the mouth
- a recent tooth extraction
Your doctor may diagnose this condition by performing a physical exam, fluid cultures, and imaging tests.
A doctor’s observations of the following symptoms are usually the basis for diagnosis of Ludwig’s angina:
- Your head, neck, and tongue may appear red and swollen.
- You may have swelling that reaches to the floor of your mouth.
- Your tongue may have extreme swelling.
- Your tongue may be out of place.
If your doctor can’t diagnose you with just a visual examination, they may use other tests. Contrast-enhanced MRI or CT images can confirm swelling on the floor of the mouth. Your doctor can also test fluid cultures from the affected area to identify the specific bacterium that’s causing the infection.
Clear the airway
If the swelling is interfering with your breathing, the first goal of treatment is to clear your airway. Your doctor may insert a breathing tube through your nose or mouth and into your lungs. In some cases, they need to create an opening through your neck into your windpipe. This procedure is called a tracheotomy. Doctors perform it in emergency situations.
Drain excess fluids
Ludwig’s angina and deep neck infections are serious and can cause edema, distortion, and obstruction of the airway. Surgery is sometimes necessary to drain excess fluids that are causing swelling in the oral cavity.
Fight the infection
It’s likely you’ll need antibiotics through your vein until the symptoms go away. Afterward, you’ll then continue antibiotics by mouth until tests show that the bacteria are gone. You’ll need to get treatment for any additional dental infections as well.
Get further treatment
You might need further dental treatment if a tooth infection caused the Ludwig’s angina. If you continue to have problems with swelling, you may need surgery to drain the fluids that are causing the area to swell.
Your outlook depends on the severity of the infection and how quickly you seek treatment. Delayed treatment increases your risk for potentially life-threatening complications, such as:
- a blocked airway
- sepsis, which is a severe reaction to bacteria or other germs
- septic shock, which is an infection that leads to dangerously low blood pressure
With proper treatment, most people make a full recovery.
You can decrease your risk of developing Ludwig’s angina by:
- practicing good oral hygiene
- having regular dental checkups
- seeking prompt treatment for tooth and mouth infections
If you’re planning on getting a tongue piercing, make sure it’s with a professional using clean, sterile tools. See your doctor immediately if you have excess bleeding or the swelling isn’t going down.
You should brush your teeth twice every day and use mouthwash with antiseptic liquid once per day. Never ignore any pain in your gums or teeth. You should see your dentist if you notice a foul smell coming from your mouth or if you’re bleeding from your tongue, gums, or teeth.
Pay close attention to any problems in your mouth area. See your doctor immediately if you have a compromised immune system or have recently had some sort of trauma in your mouth, including a tongue piercing. If you have a mouth injury, make sure to see your doctor so that they can ensure it’s healing properly.
- Candamourty, R., Venkatachalam, S., Babu, M. R. R., & Kumar, G. S. (2012). Ludwig’s angina – An emergency: A case report with literature review. Journal of Natural Science, Biology and Medicine, 3(2), 206-208. Retrieved from
- McKellop, J., & Mukherji, S. (n.d.). Emergency head and neck radiology: neck infections. Retrieved from http://www.appliedradiology.com/articles/emergency-head-and-neck-radiology-neck-infections
- Sasaki, C. (2014, November). Submandibular space infection. Retrieved from http://www.merckmanuals.com/professional/ear_nose_and_throat_disorders/oral_and_pharyngeal_disorders/submandibular_space_infection.html